Usage
- Activated charcoal is used to treat poisonings and drug overdoses. It works by adsorbing toxins in the gastrointestinal tract, preventing their absorption into the bloodstream. It can also be used to reduce gas and bloating.
- Pharmacological classification: Adsorbent, antidote.
- Mechanism of Action: Activated charcoal’s porous structure allows it to bind to various substances, including toxins and drugs, thereby reducing their systemic absorption. It does not chemically neutralize or alter the toxins but rather traps them within its pores.
Alternate Names
- Activated Carbon
- Medicinal Charcoal
How It Works
- Pharmacodynamics: Activated charcoal acts locally in the gastrointestinal tract. Its primary effect is the adsorption of toxins, preventing their entry into systemic circulation.
- Pharmacokinetics: Activated charcoal is not absorbed systemically. It passes through the gastrointestinal tract and is eliminated in the feces along with the adsorbed substances.
- Mode of Action: Adsorption to the surface of the activated charcoal is the primary mechanism. It does not involve receptor binding, enzyme inhibition, or neurotransmitter modulation. The large surface area provided by its porous structure facilitates the binding of various molecules.
- Elimination Pathways: Primarily excreted in feces.
Dosage
Standard Dosage
Adults:
- 50 to 100 grams orally as a single dose for poisoning or overdose.
- For flatulence, 200 mg orally once or twice daily.
Children:
- 1 to 12 years: 25 to 50 grams orally as a single dose.
- Under 1 year: 1 g/kg of body weight orally.
- Pediatric safety considerations: Use with caution in children under one year of age. Ensure adequate airway protection.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically necessary, but consider factors like decreased gastrointestinal motility.
- Patients with Renal Impairment: No dose adjustment necessary as activated charcoal is not renally cleared.
- Patients with Hepatic Dysfunction: No dose adjustment necessary.
- Patients with Comorbid Conditions: Use with caution in patients with compromised airway protection or swallowing difficulties.
Clinical Use Cases
Activated charcoal is typically not administered in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. However, it may be considered in cases of drug overdose in these settings.
- Emergency Situations: 50 to 100 grams administered orally or via gastric lavage.
Dosage Adjustments
Dosage adjustments are primarily based on the patient’s age and weight, and the suspected amount of the ingested toxin.
Side Effects
Common Side Effects
- Black stools
- Constipation
- Nausea and vomiting
Rare but Serious Side Effects
- Aspiration (inhalation of charcoal into the lungs)
- Bowel obstruction
Long-Term Effects
No significant long-term effects are associated with activated charcoal used for acute poisoning or overdose.
Adverse Drug Reactions (ADR)
- Pulmonary aspiration: This is a serious ADR that can lead to respiratory distress and should be managed as a medical emergency.
Contraindications
- Patients with unprotected airways
- Patients who have ingested corrosive substances (e.g., acids or alkalis)
- Patients with ileus or bowel obstruction
Drug Interactions
Activated charcoal can adsorb other drugs administered concurrently, reducing their effectiveness. Administer other medications at least 2 hours before or after activated charcoal.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Generally considered safe for use in pregnancy.
- Breastfeeding: Limited information suggests minimal excretion in breast milk; generally considered compatible with breastfeeding.
Drug Profile Summary
- Mechanism of Action: Adsorption of toxins in the gastrointestinal tract.
- Side Effects: Black stools, constipation, nausea, vomiting; rarely, aspiration or bowel obstruction.
- Contraindications: Unprotected airways, corrosive substance ingestion, ileus, bowel obstruction.
- Drug Interactions: Can reduce the absorption of other drugs.
- Pregnancy & Breastfeeding: Generally considered safe.
- Dosage: Adults: 50-100g; Children: 25-50g (1-12 years), 1g/kg (<1 year).
- Monitoring Parameters: Monitor patient’s airway, vital signs, and bowel movements.
Popular Combinations
Activated charcoal is typically used alone. Sorbitol may be co-administered in some poisoning cases to promote bowel movement, but this is not a standard practice.
Precautions
- General Precautions: Protect the patient’s airway, especially in cases of decreased level of consciousness.
- Specific Populations: Use caution in young children, the elderly, and patients with swallowing difficulties.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Activated Charcoal?
A: Adults: 50-100g; Children: 25-50g (1-12 years), 1g/kg (<1 year).
Q2: How does activated charcoal work?
A: It adsorbs toxins in the GI tract, preventing systemic absorption.
Q3: What are the common side effects?
A: Black stools, constipation, nausea, and vomiting.
Q4: When is activated charcoal contraindicated?
A: In patients with unprotected airways, ingestion of corrosive substances, or bowel obstruction.
Q5: Can activated charcoal be used in pregnancy?
A: Generally considered safe, but consult with a specialist for guidance.
Q6: Does activated charcoal interact with other medications?
A: Yes, it can reduce the absorption of other drugs. Separate administration by at least 2 hours.
Q7: How is activated charcoal administered?
A: Typically orally as a powder mixed with water or as a pre-mixed suspension.
Q8: What should I monitor after administering activated charcoal?
A: Monitor airway, vital signs, and bowel movements. Watch for signs of aspiration.
Q9: Can activated charcoal be used for all types of poisoning?
A: No, it is not effective for certain poisonings, such as those involving corrosive substances, heavy metals like iron or lead, or alcohols like methanol or ethylene glycol.
